Mpotsaris Anastasios, Kabbasch Christoph, Borggrefe Jan, Gontu Vamsi, Soderman Michael
1 Department of Neuroradiology, University Hospital of Cologne, Germany.
2 Neuroradiology, Nottingham University Hospitals NHS Trust, UK.
Interv Neuroradiol. 2017 Apr;23(2):159-165. doi: 10.1177/1591019916681983. Epub 2016 Dec 13.
Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results A total of 63 patients with a median age of 67 years (range 33-84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1-29). Median time from stroke onset to recanalization was 408 minutes (range 165-1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15-202 minutes] vs. 130 minutes [range 60-280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0-2) after three months. Conclusions Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high technical success, reasonable clinical outcomes and acceptable rates of symptomatic intracranial haemorrhage in carefully chosen patients which are triaged interdisciplinary based on clinical and computed tomography imaging criteria. This warrants further study in a randomised prospective trial.
颅外颈内动脉紧急支架置入联合前循环取栓术是一种常规手术。然而，这种情况下的精确适应症和临床安全性仍存在争议。目前机械取栓的数据包括很少有关于串联闭塞急性支架置入的研究。我们在一家综合性卒中中心对所有连续病例进行回顾性分析，评估了这种血管内治疗的可行性、安全性和临床结果。
这是一项对所有连续的急性颅外颈动脉闭塞患者的回顾性分析，这些患者包括急性夹层或重度狭窄以及伴有颅内大血管闭塞，并在2007年11月至2015年5月期间接受了紧急颈动脉支架置入和颅内机械取栓治疗。
共治疗了63例患者，中位年龄为67岁（范围33 - 84岁）。其中，33例（52%）患者最初同时接受了重组组织型纤溶酶原激活剂静脉溶栓治疗。入院时美国国立卫生研究院卒中量表中位评分为14分（范围1 - 29分）。从中风发作到再通的中位时间为408分钟（范围165 - 1846分钟）。静脉溶栓后的手术时间明显更短（110分钟[范围15 - 202分钟]对130分钟[范围60 - 280分钟]；p = 0.02）。3例（5%）患者术后出现症状性脑出血。在55/63（87%）例患者中，脑梗死溶栓量表评分可达到≥2b分。8例（占13%）患者死亡，5例（占8%）在急性期死亡。3个月后，共有29/63（46%）例患者显示出良好的预后（改良Rankin量表评分为0 - 2分）。
我们对颅外颈内动脉紧急支架置入联合前循环取栓术的单中心回顾性分析表明，在经过精心挑选、根据临床和计算机断层扫描成像标准进行多学科分诊的患者中，该手术具有较高的技术成功率、合理的临床结果和可接受的症状性颅内出血发生率。这值得在一项随机前瞻性试验中进一步研究。
